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Τρίτη 6 Απριλίου 2021

Man With Fever and Groin Mass

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A 54-year-old man with a history of hypertension, hyperuricemia, and dyslipidemia presented to the emergency department (ED) with fever and a mass in the left side of the groin since 3 days earlier. One month before presenting to the ED, he received a diagnosis of a urinary tract infection and was treated with oral antibiotics. On arrival in the ED, he was well oriented and had a temperature of 38.1°C and 100.58 °F. Physical examination revealed a firm, tender, longitudinal mass over the left side of the groin (Figure 1).
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High prevalence of methotrexate use in patients with Epstein–Barr virus-positive mucocutaneous ulcer may cause confounding bias

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Modern Pathology, Published online: 23 March 2021; doi:10.1038/s41379-021-00798-7

High prevalence of methotrexate use in patients with Epstein–Barr virus-positive mucocutaneous ulcer may cause confounding bias
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Inflammatory rhabdomyoblastic tumor with progression to high-grade rhabdomyosarcoma

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Modern Pathology, Published online: 23 March 2021; doi:10.1038/s41379-021-00791-0

Inflammatory rhabdomyoblastic tumor with progression to high-grade rhabdomyosarcoma
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Toward a unifying entity that encompasses most, but perhaps not all, inflammatory leiomyosarcomas and histiocyte-rich rhabdomyoblastic tumors

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Modern Pathology, Published online: 24 March 2021; doi:10.1038/s41379-021-00797-8

Toward a unifying entity that encompasses most, but perhaps not all, inflammatory leiomyosarcomas and histiocyte-rich rhabdomyoblastic tumors
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PDGFB RNA in situ hybridization for the diagnosis of dermatofibrosarcoma protuberans

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Modern Pathology, Published online: 24 March 2021; doi:10.1038/s41379-021-00800-2

PDGFB RNA in situ hybridization for the diagnosis of dermatofibrosarcoma protuberans
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A Cross-sectional Analysis of High-Acuity Professional Services Performed by Urban and Rural Emergency Care Physicians Across the United States

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We seek to examine differences in the provision of high-acuity professional services between rural and urban physicians receiving reimbursement for emergency care evaluation and management services from Medicare fee-for-service Part B.
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Managing a Cutaneous Abscess in the Emergency Department

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Cutaneous abscesses are a common type of skin and soft tissue infection observed in the emergency department (ED). Patients typically present with painful, erythematous nodules, which are often indurated and surrounded by an erythematous and edematous border.1,2 The overlying skin may have palpable fluctuance, surrounding cellulitis, and signs of spontaneous drainage.1,2
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IBCC – Alcoholic hepatitis

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We are seeing an increased volume of alcoholic liver disease due to the COVID pandemic.  Previously admissions to ICU for alcoholic hepatitis were rare, but these are now occurring with regularity. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

EMCrit Project by Josh Farkas.

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Prevalence of hearing loss in school aged Nepalese children

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Int J Pediatr Otorhinolaryngol. 2021 Apr;143:110658. doi: 10.1016/j.ijporl.2021.110658. Epub 2021 Feb 19.

ABSTRACT

OBJECTIVES: The main objective of this study is to identify the prevalence of hearing loss in school aged children of Nepal.

METHODS: This cross-sectional study was carried out on school aged children attending the government run schools of Nepal. A total of 79,340 children from grades 1 through 10 were included in the study. After taking brief history about ear diseases and hearing loss, children were screened for ear diseases in their respective classroom by otoscope. Hearing evaluation was carried out by pure tone audiometer and hearing threshold was obtained at 0.5-4 kHz. The results were then documented and analyzed.

RESULTS: The prevalence of hearing impairment in school aged children in Nepal is found to be 5.73% (4551 of 79,340). Conductive hearing loss was the most common type of hearing loss and was o bserved in 70.47% (n = 3207) of the children.

CONCLUSIONS: This study shows that hearing loss is a common problem in children of Nepal. With the main cause of hearing loss due to preventable conditions such as chronic otitis media, it is believed that early standardized screening, detection and timely management of chronic otitis media in these children can prevent hearing loss and its impact on their educational, social and language development. School based ear health programs are a useful community-oriented solution for prevention of deafness. It shows how important it is to introduce hearing screening for primary school aged children to prevent hearing loss.

PMID:33636508 | DOI:10.1016/j.ijporl.2021.110658

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Monopolar electrocautery tip vs plasma ablation in tonsillotomy: A randomized case-control study comparing outcomes in pediatric population

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Int J Pediatr Otorhinolaryngol. 2021 Apr;143:110655. doi: 10.1016/j.ijporl.2021.110655. Epub 2021 Feb 20.

ABSTRACT

BACKGROUND: The objective of this study was to compare the low-priced monopolar electrocautery to the high-priced, worldwide used, plasma ablation in tonsillotomy among children aged between three and twelve years, suffering from obstructive breathing disorders (OBD), with respect to post-operative pain, bleeding and related morbidities.

METHODS: A randomized case-control study was conducted in the Eye and Ear Hospital International- Lebanon. 103 children aged between three and twelve years suffering from OBD secondary to tonsillar hypertrophy were randomly assigned into two groups. Post-operative pain was evaluated using age-adequate validated scales: "FLACC-R" (Face, Legs, Activity, Cry, Consolability-Revised) for children aged less than five years, and "Wong Baker faces" for older children. Additional post-operati ve outcomes were evaluated using Pain-PROM (Patient reported Pain-Related Outcome Measures) and TAHSI (Tonsil and Adenoid Health Status Instrument) scales.

RESULTS: Significantly, higher rates of patients who underwent tonsillotomy via plasma ablation technique used analgesics and had severe pain compared to the monopolar electrocautery group. A longer operative duration was significantly associated with higher pain scores, and the plasma ablation technique yielded significantly higher operative mean durations. 10 days post-operatively, a significantly higher percentage of children reported an overall high pain severity and more than expected overall pain when using the plasma ablation technique compared to the monopolar electrocautery one. Overall bleeding rates were similar. No difference was reported one month post-operatively.

CONCLUSION: When compared to plasma ablation, monopolar electrocautery, can provide the same efficiency in relieving OBD in healthy children, with equal overall bleeding rates, but significantly lower cost, operating time, pain scores and need for analgesics.

PMID:33639493 | DOI:10.1016/j.ijporl.2021.110655

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The otolaryngologic manifestations of Sotos syndrome 1: A systematic review

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Int J Pediatr Otorhinolaryngol. 2021 Apr;143:110649. doi: 10.1016/j.ijporl.2021.110649. Epub 2021 Feb 12.

ABSTRACT

OBJECTIVES: Sotos syndrome 1 (SOTOS1; MIM:117550) is rare genetic disorder characterized by excessive physical growth before and after birth, distinctive facial features, a large and elongated head, and intellectual disability (Sotos et al., 1964; Tatton-Brown et al., 1993). This systematic review aims to determine otolaryngologic conditions and complications of SOTOS1 based on existing literature through a review of current and past case reports and studies regarding SOTOS1.

METHODS: A systematic review of all published literature (1964-2020) describing otolaryngologic conditions and/or complications of patients with SOTOS1. Twenty journal articles met inclusion criteria. These articles included 160 patients diagnosed with SOTOS1.

RESULTS: Of the 160 individuals with SOTOS1 included in this review, 22 (14%) we re reported to have otologic conditions. 4 (3%) individuals were reported to have conditions involving the thyroid and parathyroid glands. 2 (1%) individuals were reported to have head & neck tumors. 39 (24%) individuals were reported to have congenital malformations or abnormalities of the head & neck. 47 (29%) individuals were reported to have feeding difficulties. 16% of individuals were reported to have other otolaryngologic conditions.

CONCLUSIONS: Our review found multiple otolaryngologic conditions present in patients with SOTOS1, including hearing loss, otitis, hyperthyroidism, hypothyroidism, head & neck tumors, congenital malformations (high arched palate, cleft lip and palate, macroglossia), feeding difficulties, respiratory difficulties, and speech disorders. Additional studies should be conducted to further assess these associations.

PMID:33640723 | DOI:10.1016/j.ijporl.2021.110649

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Improving community-based care for children with a rare condition: The example of long-segment congenital tracheal stenosis and perceptions of health professionals, parents and teachers

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Int J Pediatr Otorhinolaryngol. 2021 Apr;143:110651. doi: 10.1016/j.ijporl.2021.110651. Epub 2021 Feb 14.

ABSTRACT

BACKGROUND: Long segment congenital tracheal stenosis (LSCTS) is a rare, complex condition which is often poorly understood by community-based health professionals (HPs). Anecdotally, such HPs often lack confidence providing care for children, resulting in children being brought to the tertiary centre more frequently than necessary. We wanted to identify the information and support needs of HPs in primary and secondary care looking after a child with LSCTS, the views of those providing education to these children, and elicit parents' perceptions about community-based services, to improve overall care for children and families.

METHOD: Questionnaires were sent to 175 community-based HPs and 34 teachers involved in the care of children with LSCTS. Face-to-face or telephone interviews were conducted with 12 parents of p atients with LSCTS to establish their perceptions of community-based services.

RESULTS: Ninety (51%) completed questionnaires were returned from HPs and 18 (53%) from teachers. Responses indicated low levels of knowledge of LSCTS. Physical, practical and communication information needs were identified by all respondent groups, together with general and condition-specific concerns. Interviews with parents indicated that they thought the level of knowledge about LSCTS in the community was low, which had a negative impact on their willingness to consult local services. Better information provision for HPs, teachers and parents was identified as a means of improving outcomes.

CONCLUSION: Professionals caring for children with LSCTS in the community and in schools have unmet information and support needs, with consequences for children, families, HCPs in both the community and tertiary hospital, and teachers.

PMID:33662711 | DOI:10.1016/j.ijporl.2021.110651

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